Hyperkalemia is a common clinical problem, caused by the inability to excrete potassium due to renal impairment or drugs. The therapy is ultimately to increase potassium excretion, either via medications or by dialysis. The first cause of action however, is to shift the potassium into the cells.



Different strategies exist to assess the severity of hyperkalemia, using combinations of potassium levels, cardiac abnormalities and comorbidities. A non-complete combination of different sources follows

Severity Criteria
  • K < 5.5 – 5.9 mmol/l
  • no ECG changes
  • no renal disease
  • K 5.5 – 6.5 mmol/l
  • no ECG changes
  • renal impairment (oliguria, end-stage renal disease)
severe, hyperkalemic emergency
  • K > 6.5 mmol/l, or > 5.5. mmol/ with the following:
  • any ECG changes
  • any significant renal impairment
  • ongoing tissue breakdown, ongoing potassium absorption (e.g. gi-bleeding)


Membrane stabilization

Shift into cells

Remove potassium from the body


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